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(11) | EP 1 677 225 A1 |
| (12) | EUROPEAN PATENT APPLICATION |
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| (54) | System and method for determining patient follow-up subsequent to an orthopaedic procedure |
| (57) A patient monitoring system comprises a sensor, and a processor in communication
with the sensor. A memory device is electrically coupled to the processor. The memory
device has stored therein a plurality of instructions which, when executed by the
processor, cause the processor (a) to monitor output from the sensor to determine
the number of cycles of use of the orthopaedic joint of a patient, and (b) to generate
a message to the patient indicative of a need to initiate communication with an orthopaedic
care provider if the number of cycles of use of the orthopaedic joint exceeds a predetermined
threshold value.
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[0001] The present disclosure relates generally to systems and methods for use in conjunction with orthopaedic procedures.
[0002] Currently, patient follow-up subsequent to an orthopaedic procedure is a function of the time that has elapsed since the procedure. Indeed, follow-up meetings with the orthopaedic care provider (e.g., the surgeon) are typically scheduled for dates in the future which reflect the passage of a given amount of time since the procedure.
[0003] The present invention relates to a method for determining patient follow-up after an orthopaedic procedure, such as a joint replacement procedure, based on the actual use of the patient's joint. As will be described herein in greater detail, the number of cycles of use of the patient's joint may be determined, for example, by (i) determining number of steps taken by the patient, (ii) determining the activity level of the patient, (iii) determining the number of times a predetermined joint flexion angle is achieved, or (iv) determining the number of loading cycles of the joint. Determination of these parameters may be achieved in a number of different manners. When it is determined that the patient has achieved a level of use in which follow-up is desired, a communication with the orthopaedic care provider (e.g., a surgeon, hospital, nurse, primary care provider, or other individual involved in the care of the patient) is initiated by notifying the patient and/or the orthopaedic care provider. As will be described herein in greater detail, such communication may be achieved in a variety of different manners.
[0004] In one aspect, the invention provides a patient monitoring system, comprising:
a sensor,
a processor in communication with the sensor, and
a memory device electrically coupled to the processor, the memory device having stored therein a plurality of instructions which, when executed by the processor, cause the processor (a) to monitor output from the sensor to determine the number of cycles of use of the orthopaedic joint of a patient, and (b) to generate a message to the patient indicative of a need to initiate communication with an orthopaedic care provider if the number of cycles of use of the orthopaedic joint exceeds a predetermined threshold value.
[0005] In a further aspect, the invention provides a method of determining patient follow-up subsequent to an orthopaedic procedure includes determining the number of cycles of use of an orthopaedic joint of the patient. If a predetermined threshold is exceeded, communication with an orthopaedic care provider is initiated.
[0006] In another aspect, the invention provides a method of determining patient follow-up subsequent to an orthopaedic procedure, the method comprising the steps of:
electronically querying a joint use measurement device to determine the number of cycles of use of an orthopaedic joint of a patient, and
generating an electronic output signal if the number of cycles of use of the orthopaedic joint of the patient exceeds a predetermined threshold value.
[0007] The number of cycles of use of the patient's joint may be determined by (i) determining number of steps taken by the patient, (ii) determining the activity level of the patient, (iii) determining the number of times a predetermined joint flexion angle is achieved, or (iv) determining the number of loading cycles of the joint.
[0008] The communication with the orthopaedic care provider (often a surgeon) is initiated by notifying the patient and/or the orthopaedic care provider. Such communication may be initiated by a phone call, electronic mail message, or other web-based communication. Such a communication may be an automated, device-initiated communication.
[0009] The orthopaedic joint of the patient may be a prosthetic joint. The orthopaedic joint of the patient may have at least one natural orthopaedic component.
[0010] A patient monitoring system includes a joint use measurement device configured to determine the cycles of use of an orthopaedic joint of a patient.
[0011] The joint use measurement device is operable to generate a message if a predetermined threshold is attained.
[0012] Embodiments of the invention will now be described by way of example with reference to the accompanying drawings, in which:
FIG. 1 is a diagrammatic view showing a joint use measurement device in the form of a pedometer being utilized to determine the cycles of use of a knee endoprosthesis system;
FIG. 2 is a diagrammatic view showing a joint use measurement device in the form of a electronic body monitor being utilized to determine the cycles of use of a knee endoprosthesis system;
FIG. 3 is a diagrammatic view showing a joint use measurement device in the form of an implantable joint cycle counter being utilized to determine the cycles of use of a knee endoprosthesis system; and
FIG. 4 is a diagrammatic view showing a joint use measurement device in communication with a communication device.
[0013] Referring to the drawings, FIG. 1 shows a joint use measurement device 10 which can be used to determine the number of cycles of use of a prosthetic orthopaedic joint 12. In the exemplary arrangement of FIG. 1, the orthopaedic joint 12 is exemplary embodied as a knee endoprosthesis system 14 for use in a total knee replacement procedure. The knee endoprosthesis system 14 is implanted on the distal end of the femur 16 and the proximal end of the tibia 18. The endoprosthesis system 10 includes a tibial bearing 20 that is positioned on the proximal tibial component 22. The proximal tibial component 22 is affixed to the proximal end of the tibia 18. The tibial bearing 20 has a contoured proximal surface 24, against which the condyles 26 of the distal femoral component 28 bear. The distal femoral component 28 is affixed to the distal end of the femur 16. Articulation of the joint is at the interface of the proximal surface 24 of the tibial bearing 20 and the condyles 26 of the distal femoral component 28.
[0014] The actual use of the knee endoprosthesis system 14 may be characterized as cycles of use of the system. The cycles of use of the system 14 may be measured in a variety of methods such as, for example, (i) by determining number of steps taken by the patient, (ii) by determining the activity level of the patient, (iii) by determining the number of times a predetermined joint flexion angle is achieved by the system 14, or (iv) by determining the number of loading cycles of the system 14.
[0015] In the embodiment shown in FIG. 1, the joint use measurement device 10 is embodied as a pedometer 30. The pedometer 30 is worn by the patient subsequent to the patient's orthopaedic procedure to determine the number of steps taken by the patient. When the output from the pedometer 30 indicates that the patient has taken a predetermined number of steps since the patient's orthopaedic procedure (or since the patient's previous meeting with the surgeon), a communication with the orthopaedic surgeon may be initiated. For example, the patient may make an appointment with the surgeon's office via telephone, electronic mail or other web-based communication, conventional mail, etcetera.
[0016] Referring now to FIG. 2, there is shown an arrangement similar to FIG. 1, but showing the joint use measurement device 10 embodied as an electronic body monitor 32. The electronic body monitor 32 is configured to be worn externally of the patient's body such as, for example, on an armband. Like the pedometer 30 of FIG. 1, the electronic body monitor 32 may be used to determine the number of steps taken by the patient over a given period of time (e.g., since the patient's procedure or since the patient's previous post-surgical meeting with the surgeon). The electronic body monitor 32 may also execute algorithms for determining and tracking the activity level of the patient. In this way, follow-up may be initiated as a function of steps taken by the patient, activity level of the patient, or both.
[0017] As shown in FIG. 2, the electronic body monitor 32 includes a sensor 34 that is configured to sense parameters associated with cycles of use of the knee endoprosthesis system 14. The sensor 34 may be embodied as a single sensor or as an array of sensors. In one exemplary embodiment, the sensor 34 is embodied as a two-axis accelerometer the output from which may be used to determine the number of steps taken by the patient. The electronic body monitor 32 also includes a processor 36 electrically coupled to the sensor 34, a memory device 38, and a data output port 40. The processor 36 is electrically coupled to the data output port 40 and the memory device 38. The electronic body monitor 32 may also include other devices useful in a computing device such as drivers, registers, buffers, digital signal processors, and the like. Illustratively, the electronic body monitor 32 may be embodied, with or without modification thereto, as any one of the numerous body monitors commercially available from BodyMedia Inc of Pittsburgh, Pennsylvania. One such device is commercially sold under the trade mark SenseWare PRO.
[0018] The processor 36 and memory device 38 cooperate to determine when follow-up subsequent to an orthopaedic procedure is warranted based on cycles of use of the knee endoprosthesis system 14. In particular, the memory device 38 has stored therein a plurality of instructions in the form of a software routine which performs such a function. The memory device 38 may be Random Access Memory (hereinafter sometimes RAM), Read Only Memory (hereinafter sometimes ROM), flash or erasable memory such as Erasable Programmable ROM (hereinafter sometimes EPROM) and Electrically Erasable Programmable ROM (hereinafter sometimes EEPROM), and/or other memory devices. Due to the adaptable nature of programming languages, there are many embodiments of a software routine stored in the memory device 38 for performing such a function.
[0019] The electronic body monitor 32 also includes a message generating device 42. The message generating device 42 is operable to generate visual and/or audible messages for presentation to the patient. For example, when the electronic body monitor 32 determines that the patient has exceeded a predetermined threshold relating to the number of steps taken by the patient (or activity level) since the patient's procedure (or last meeting with the surgeon), an audible and/or visual alert may be generated by the message generating device 42. The message generating device 42 may be embodied as any type of such device including, for example, an LCD or LED display and/or a tone/sound generator.
[0020] Referring now to FIG. 3, the joint use measurement device 10 includes an implanted sensor 50. The sensor 50 may be embodied as a single sensor or as an array of sensors. In the exemplary embodiment of FIG. 3, the implanted sensor 50 includes a signal source 52, such as a permanent magnet, that is embedded in the distal femoral component 28, and a sensor 54, such as a Hall effect switch, embedded in the proximal tibial component 22. The associated electronics 56 are also secured to the proximal tibial component 22. The electronics 56 include, amongst other things, a processor, memory device, power source, modulator, a transmitter, and antenna to facilitate the maintenance of a running count of the number of times the knee endoprosthesis system 14 cycles, along with the ability to transmit such a count from within the patient's body. In other words, the joint use measurement device 10 illustrated in FIG. 3 utilizes an implanted sensor to determine the number of occasions in which the components of the knee endoprosthesis system 14 are in a predetermined relative position with one another (e.g., the number of occasions in which a predetermined flexion angle is attained), thereby determining cycles of use of the system 14.
[0021] The stored count information can be transmitted to a device external to the patient's body by use of the transmitter and antenna of the associated electronics 56. As shown schematically in FIG. 3, an external receiver 58 and data interpretation device 60 may be used to retrieve information from the implanted electronics 56. The external receiver 58 may be embodied as a radio-frequency antenna that is operable to receive the signal from the internal antenna of the implanted electronics 56. The data interpretation device 60 is electrically coupled to the receiver 58, and may be embodied as a standard computer (e.g., PC) programmed to demodulate the radio-frequency signal received from the internal transmitter and the internal antenna of the implanted electronics 56. The data interpretation device 60 may also be embodied as a hand-held personal computer, a personal desk assistant, a laptop computer, or any custom-designed data acquisition device. The data interpretation device 60 may be programmed to perform calculations necessary to convert the received and demodulated signal into the number of cycles recorded by the counter.
[0022] One such implantable system, along with the associated external components, is disclosed in US-A-2005/0010299.
[0023] The data interpretation device 60 may have integrated therein, or be coupled to, a message generating device 62. The message generating device 62 is operable to generate visual and/or audible messages for presentation to the patient. For example, when it is determined from the output of the implanted electronics 56 that the number of occasions in which the knee endoprosthesis system 14 has attained a predetermined flexion angle has exceeded a predetermined threshold, an audible and/or visual alert may be generated by the message generating device 62. The message generating device 62 may be embodied as any type of such device including, for example, a PC display monitor, an LCD or LED display, and/or a tone/sound generator.
[0024] In lieu of the arrangement of FIG. 3 which includes a magnet and Hall effect switch, other implanted sensor arrangements are also contemplated. For example, a load sensor may be implanted into the knee endoprosthesis system 14. In such a system, the cycles of use of the system 14 could be determined by counting loading cycles of the system. Such a count could be stored, transmitted, and received in a similar manner to as described above in regard to the arrangement of FIG. 3.
[0025] In another example, the cycles of use of the patient's joint may be determined by measuring the wear of certain components of the knee endoprosthesis system 14. For instance, a sensor arrangement may be utilized in which the joint space between the femoral component 28 and the tibial component 22 is measured/monitored. It should be appreciated that such a distance may shorten (i.e., reduce) over cycles of the knee endoprosthesis system as a result of wear of the tibial bearing 20. As such, the cycles of use of the system 14 could be determined by measuring and tracking the joint space between the femoral component 28 and the tibial component 22. Such data could be stored, transmitted, and received in a similar manner to as described above in regard to the arrangement of FIG. 3. One such implantable system, along with the associated external components, is disclosed in US-A-2005/0010301.
[0026] Referring now to FIG. 4, there is shown the joint use measurement device 10 being used in conjunction with a communications device 70. The communications device 70 may be embodied as hardware and software that is integrated into a personal computer, wireless (e.g., cellular) telephone, PDA, or home automation system. Alternatively, the communications device 70 may be a discreet hardware/software assembly electrically coupled to a personal computer, wireless (e.g., cellular) telephone, PDA, or home automation system. In either case, the communications device 70 includes devices useful in a computing device such as microprocessor(s), memory devices, drivers, registers, buffers, digital signal processors, and the like
[0027] The communications device 70 may be operated to query the joint use measurement device 10 and then commence an automated, device-initiated communication with the orthopaedic care provider (e.g., the surgeon's office) if a follow-up visit is warranted based on the number of cycles of use of the knee endoprosthesis system 14. For example, the communications device 70 may initiate a telephone call, electronic mail communication, or other web-based communication with an electronic device or system 72 operated by the surgeon's office.
[0028] It should be appreciated that the communications device 70 may be configured to accommodate any one or more of the different exemplary embodiments of the joint use measurement device 10. For example, in the case of the electronic body monitor 32 of FIG. 2, the communications device 70 may be configured to communicate with the body monitor 32 via its data output port 40. Such a communication may be wired or wireless depending on the configuration of the port 40. It is contemplated to integrate the communications device 70 into the electronic body monitor 32.
[0029] Similarly, the communications device 70 may be configured to communicate with data interpretation device 60 of the arrangement of FIG. 3 via either a wired or wireless communication link. It should be appreciated that the communications device 70 may be integrated into the data interpretation device 60 (i.e., a single device, such as a PC, may be equipped with the necessary hardware and software to perform both the functions of the data interpretation device 60 and the functions of the communications device 70).
[0030] In the case of when the joint use measurement device 10 is embodied as a mechanical device (i.e., non-electrical) such as, for example, certain types of pedometers, data from the mechanical device may be input into the communications device 70. In such a case, the communications device 70 may be configured to process such manually entered data, and then, if appropriate, initiate communication with the surgeon in any one or more of the manners described above.
[0031] The concepts described herein can be applied to joint endoprostheses other than knee joint prostheses, such as endoprosthesis systems for use in the hip, shoulder, wrist, elbow, ankle, along with endoprosthesis systems for use with the digits of the extremities. It should be understood that other configurations of a joint use measurement device (including its sensors) may be utilized to accommodate a given application in a desired joint location.
1. A patient monitoring system, comprising:
a sensor,
a processor in communication with the sensor, and
a memory device electrically coupled to the processor, the memory device having stored therein a plurality of instructions which, when executed by the processor, cause the processor (a) to monitor output from the sensor to determine the number of cycles of use of the orthopaedic joint of a patient, and (b) to generate a message to the patient indicative of a need to initiate communication with an orthopaedic care provider if the number of cycles of use of the orthopaedic joint exceeds a predetermined threshold value.
2. The patient monitoring system of claim 1, wherein the sensor is implantable into the
body of the patient.
3. The patient monitoring system of claim 1, wherein the sensor is configured to be externally
worn by the patient.
4. The patient monitoring system of claim 1, wherein the sensor is secured to a prosthetic
joint component.
5. A method of determining patient follow-up subsequent to an orthopaedic procedure,
the method comprising the steps of:
electronically querying a joint use measurement device to determine the number of cycles of use of an orthopaedic joint of a patient, and
generating an electronic output signal if the number of cycles of use of the orthopaedic joint of the patient exceeds a predetermined threshold value.
6. The method of claim 5, wherein the generating step comprises generating a phone message
which is sent to an orthopaedic care provider.
7. The method of claim 5, wherein the generating step comprises generating an electronic
mail message which is sent to an orthopaedic care provider.
8. The method of claim 5, wherein:
the joint use measurement device comprises a sensor implanted into the body of the patient, and
the electronically querying step comprises determining output from the sensor.
9. The method of claim 5, wherein
the joint use measurement device is configured to be externally worn by the patient,
the joint use measurement device comprises a sensor, and
the electronically querying step comprises determining output from the sensor.
the joint use measurement device is configured to be externally worn by the patient,
the joint use measurement device comprises a sensor, and
the electronically querying step comprises determining output from the sensor.
10. A method of determining patient follow-up subsequent to an orthopaedic procedure,
the method comprising the steps of:
determining the number of cycles of use of an orthopaedic joint of a patient, and
initiating communication with an orthopaedic care provider in response to the determining step.